iHV and Barnardo’s launch new MMR vaccination film #WorldImmunizationWeek

As highlighted by Professor Helen Bedford in the February 2024 iHV podcast “Stemming the measles surge”, measles is on the rise in the UK, with 6/10 of the confirmed cases in the under 10s in England¹.

At the same time, rates of MMR vaccination continue to decline², this can be seen in the graph below, which highlights the recovery in MMR vaccination uptake, following the discrediting of the Wakefield study. However, from 2019/20 the rates start to fall again. In 2022/23, for the uptake of both doses, this had fallen to 84.5% in England, 89.5% in Wales, 90.2% in Scotland and 87.9% Northern Ireland, all of which are below the World Health Organization (WHO) target of 95%².

There are a number of reasons why parents choose not to have their children fully vaccinated against MMR. In some cases, there is a lack of awareness of the potential severity of measles, mumps and rubella if contracted. For some parents, vaccination appointments are delivered in locations that are not easily accessible for them, with limited choice or flexibility around timings to make sure that they are available at convenient times for busy families. Some parents may also be anxious about the MMR vaccine and its side effects.

It is therefore important that all families have access to accurate information and opportunities to have their questions answered by trusted health professionals.

New Video

iHV and Barnardo’s have worked together to develop a film for families about the MMR vaccination to improve vaccine uptake. It features a real-life couple, Radhika and Manish, discussing their decision to get their son, Kabeer, vaccinated and their experience of the process. They share their initial challenges finding trusted information online, and the importance of vaccination, not only for their own child but for vulnerable family and friends at greater risk of serious complications linked to these diseases. They also strongly advise parents who may have doubts about the MMR vaccine to talk to a health professional, such as their health visitor or GP, who can provide trusted and evidence-based advice. A lovely moment in the video is hearing them describe how proud their son Kabeer was of his vaccination certificate, as he showed it to his friends at nursery.

The video is freely available on the link below, so please share with families and on your social media.

Watch iHV and Barnardo's short video on the importance of MMR vaccinations

Health visitors’ vital role

When discussing the MMR vaccination with families, as well as encouraging them to have their child/ren vaccinated, it is important to remind them that:

Unvaccinated children are at high risk of contracting measles, mumps and rubella – these are all potentially serious diseases that can cause significant health problems.
Measles can lead to pneumonia, meningitis, blindness and seizures in children; and miscarriage, stillbirth, premature birth or a baby born with a low birthweight in those who are pregnant³.
Mumps can cause viral meningitis, although serious complications are thankfully rare⁴.
And while rubella is rare in pregnancy, it can cause miscarriage and serious problems in the baby including with their sight, hearing, heart or brain⁵.
There is a measles surge in the UK now – it is never too late to get their child vaccinated to protect them and the wider community.

Health visitors and the wider skill-mix team have a vital role to play in improving vaccine uptake. Please use every opportunity to support families to check their child’s vaccine status, answer any questions that they might have with accurate information, and connect families to their GP, or local vaccine initiatives in your area, to promote vaccine uptake.

RCPCH resources

The Royal College of Paediatric and Child Health has some great resources about measles which you can access here.

References

UKHSA (2024) News story Latest measles statistics published.
https://www.gov.uk/government/news/latest-measles-statistics-published
Harker, R. (2024) Childhood Immunisation Statistic. House of Commons Library. Number 8556. https://researchbriefings.files.parliament.uk/documents/CBP-8556/CBP-8556.pdf
NHS (2022) Measles.
https://www.nhs.uk/conditions/measles/
NHS (2021) Mumps.
https://www.nhs.uk/conditions/mumps/
NHS (2022) Rubella (german measles).
https://www.nhs.uk/conditions/rubella/

Whooping cough infections rise

New data published by the UK Health Security Agency (UKHSA) shows there has been a continued increase in pertussis (whooping cough) cases at the start of this year, with 553 confirmed in England in January, compared with 858 cases for the whole of last year (2023).

The increase in whooping cough across England is occurring after a prolonged period of low case numbers due to restrictions and reduced social mixing patterns during the COVID-19 pandemic. Cases of whooping cough rise cyclically every few years, with the last peak year in 2016 recording 5,949 cases. The current increase is coming at a time when there has been a steady decline in uptake of the vaccine in pregnant women and in children.

Vaccination programme for children and pregnant women

In response to increasing case numbers, the UKHSA is reminding mums-to-be to get protected against whooping cough so that their young baby has protection from birth against this serious disease and to ask their midwife if they are unsure. UKHSA is also urging parents to check that their children are vaccinated against whooping cough, which is offered to all infants at 8, 12 and 16 weeks of age (as part of the 6-in-1 combination vaccine) with an additional dose included in the pre-school booster vaccine.

This reminder is part of the UKHSA’s new Childhood Immunisation Campaign urging parents to check the vaccination status of their children against measles and other serious diseases. This campaign went live across a range of media channels at the start of this week. Parents are being asked to respond to invites from the NHS or to book an appointment with their GP practice if their child has not received all their routine vaccines.

Data for January show that there were 22 infants aged under 3 months diagnosed with whooping cough. These infants, who are too young to be fully vaccinated, are at greater risk of severe disease, including death. UKHSA is strongly encouraging expectant mothers to take up the maternal vaccine. Vaccination of pregnant women is 97% effective at preventing death in young infants from whooping cough.

Useful links

NHS Vaccinations and when to have them

NHS Whooping cough information

UKHSA launches campaign as measles cases continue to rise

The UK Health Security Agency (UKHSA) has launched a new multi-media marketing campaign across England to remind parents and carers of the risk of their children missing out on protection against serious diseases that are re-emerging in the country – with an urgent call to action to catch up on missed vaccinations.

The campaign went live today (4 March) with a powerful video advert told from the perspective of children and in their voices. “Our generation’s risk of illnesses like measles and whooping cough is rising” they tell their parents and carers looking straight into camera – “If we’re not vaccinated, we’re not protected.”

The campaign theme and materials, based on insight and feedback from parents in the North West, were developed by UKHSA in partnership with DHSC Marketing, Liverpool City Council, NHS England, NHS North West and NHS Greater Manchester.

The campaign comes as the latest weekly update today on measles cases in England shows there have been another 69 cases in the past week, bringing the total number of laboratory confirmed measles cases reported since 1 October 2023 to 650.

Professor Helen Bedford, Professor of Children’s Health at UCL Great Ormond Street Institute of Child Health (GOS ICH) and iHV Expert Adviser: Immunisations, said:

Every year, vaccination saves millions of children’s lives, so it is a huge concern that uptake of vaccines has been in decline in England for the past ten years. This has left many children and young people unprotected against potentially serious diseases and we are already seeing numbers of cases of measles and whooping cough increasing. However, we can prevent this taking further hold. Vaccines are free, highly effective and have a good safety record – and it is never too late to catch up if they have been missed. We owe it to our children to ensure they are protected.

Uptake levels of childhood vaccines offered through the routine NHS vaccination programme in England have been falling over the past decade across all vaccines, including whooping cough, measles, mumps and rubella, polio, meningitis and diphtheria – with England no longer having the levels of population immunity recommended by the World Health Organization that is needed to prevent outbreaks. Crucially, lower vaccine uptake within communities is directly linked to wider health inequalities.

To counter this decline, UKHSA is co-ordinating its national marketing campaign with an NHS operational MMR catch up campaign. Areas with low uptake will be a focus for support and parents of children aged from six to 11 years will be contacted directly and urged to make an appointment with their child’s GP practice for any missed MMR vaccines.

In addition to the TV advert, the campaign will be seen across a range of channels and formats including radio advertising, digital display, online and on social media. Additional advertising will be seen in the West Midlands, North West and London where there are larger pockets of low uptake. The campaign will be supported by a number of key stakeholders, including local authorities and NHS organisations.

Also listen our our recent podcast with Professor Helen Bedford - Stemming the measles surge

NHS publishes Vaccination Strategy for all vaccination programmes

Today, NHS England has published the first national Vaccination Strategy, bringing together all vaccination programmes, to protect communities and save lives. The strategy outlines how getting vaccinations will be made easier than ever before, including through expansion of the NHS App, ‘one stop shops’ and community outreach.

Vaccinations provide one of the most effective public health interventions, preventing between 3.5 and 5 million deaths every year across the globe through childhood vaccinations alone. Whilst the UK has a comprehensive childhood immunisation programme, falling rates of vaccine uptake over the last decade are a source of considerable concern. Tackling this issue will require a whole system approach and health visitors have an important role to play.

At the end of October, the UK Health Security Agency (UKHSA) issued an urgent letter regarding preparedness for measles resurgence in England. Measles is a highly infectious disease which can only be controlled by vaccination. Through their universal work with all families, health visitors can support uptake of the MMR immunisation programme to meet the WHO target of 95% coverage with two doses of MMR vaccine by age 5 years. Achieving this target is essential to maintain measles elimination status for the UK and prevent measles outbreaks from occurring.

The new national Vaccination Strategy outlines three clear priority areas to reverse these downward trends in vaccine uptake and prevent deaths and hospitalisations from vaccine-preventable diseases. These include:

Improving access including an expansion of online services: Many more people will be able to book their vaccines online quickly and easily, including via the NHS App. Families will be able to view their full vaccination record with clear information and guidance on what vaccinations they should have to keep them well.
Vaccination delivery in convenient local places, with targeted outreach to support uptake in underserved populations: Bespoke outreach services should be tailored to communities that are un- or under-vaccinated, building trust and confidence.
A more joined-up prevention and vaccination offer: Vaccination services and activities should be holistic, offering multiple vaccinations for the whole family where appropriate.

The Strategy sets out its plans for improved integration with clinical pathways and greater joint working across all local service providers, including acute, community, mental health and local authorities. Systems should consider how they can:

Make vaccination the business of everyone working in patient-facing settings, through training and awareness campaigns. This includes using key contacts to talk to the person about relevant vaccinations, answer questions and, if they cannot deliver the vaccination there and then, signpost to the appropriate services.
Base vaccinators in healthcare settings accessed by people who may benefit most from vaccination. This may include emergency departments, outpatient departments, family hubs and community diagnostic centres. The report highlights that, “Family hubs may be especially beneficial for babies and children where parents may be less likely to access a standard offer.”
Train and deploy a wider set of professionals to deliver vaccinations. The reports states that, “Local authority services for 0–5 year-olds, for example, have unparalleled contact with underserved communities. Health visiting teams as well as school nursing teams have successfully delivered vaccinations in the past and continue to do so in parts of the country, making use of their extensive skills and relationships. Any such arrangements would need to be locally planned and take into account workforce capacity and funding requirements.”

Whilst the Vaccination Strategy does not set out all the specifics of implementation (and there will be a range of considerations that will need to be addressed), NHS England has indicated that they will continue their work with stakeholders (including the iHV) to develop their plans in order to deliver the proposals. With sufficient resource, there are significant opportunities to build on the work that has already started in Integrated Care Systems to provide more ‘joined-up’ vaccination programmes in the future, across the whole pathway including through integrated neighbourhood, place and system teams. We are particularly pleased to see the emphasis on reaching all parts of the community, with a specific focus on underserved and marginalised communities that will be needed to tackle widening health inequalities.

Professor Helen Bedford, Professor of Children’s Health, Population, Policy and Practice Programme, UCL Great Ormond Street Institute of Child Health and iHV Expert Adviser: Immunisations, commented:

The UK vaccination programme is among the most successful worldwide, yet there is room for improvement to ensure we offer maximum protection to the population against infectious disease. Each year for the past ten years, small declines in uptake of childhood vaccines, together with large disparities in uptake between geographical areas and social and economic groups, are a cause for concern. If fully implemented, the Vaccination Strategy will be vitally important to ensuring we improve our current position and placing us well to maintain the success of the programme into the future. Through their contacts with families, and the trusting relationships they build, health visitors play a key role in boosting vaccine confidence and in securing the success of the childhood vaccination programme.

Read NHS Vaccination Strategy

Read NHS Vaccination Strategy online

Read iHV Good Practice Points: Promoting the Uptake of Childhood Immunisations which contains advice on health visitors’ role supporting vaccination uptake as part of an integrated approach.

Health Visitors – please share your views on immunisations!

The UK Health Security Agency (UKHSA) is responsible for protecting everyone in the community from the impact of infectious diseases, and vaccines play an important part in this.

UKHSA would like to invite you to take part in the UKHSA survey of Health Visitors to share your experiences and thoughts on vaccination, and your views on possible new immunisations. They welcome all opinions.

We know that parents really value and trust health visitors’ advice and this anonymous survey will help UKHSA better support you in your work.

This is not a test of knowledge and there are no right or wrong answers. It will only take about 15 minutes of your time.

The survey is being conducted in collaboration with the Institute of Health Visiting and University College London Institute of Child Health.

How to take part in the survey

If you are an iHV member, you should have received an email in the last day or so with a link to the UKHSA survey – please email us at [email protected] if you did not receive this.

If you are not an iHV member (and you are a health visitor), you can still complete the UKHSA survey – please email us at [email protected].

Preparing for measles resurgence in England

Yesterday, the UK Health Security Agency (UKHSA) issued an urgent letter regarding preparing for measles resurgence in England. Tackling this issue will require a whole system approach and health visitors have an important role to play.

The UKHSA recent measles risk assessment concluded that although the risk of a UK-wide measles epidemic is considered low, a measles outbreak of between 40,000 and 160,000 cases could occur in London, due to sub-optimal uptake of the Measles Mumps and Rubella (MMR) vaccine in the capital. Evidence also shows that, outside of London, there is a high risk of cases linked to overseas travel leading to outbreaks in specific population groups. There has been a steady rise in measles cases this year.

Health visitors can play a crucial role in increasing uptake of the MMR immunisation programme to meet the WHO target of 95% coverage with two doses of MMR vaccine by age 5 years. Achieving this target is essential to maintain measles elimination status for the UK and prevent measles outbreaks from occurring. This is a NHS Long-Term Plan (LTP) commitment and high priority within NHS England.

Key messages:

Raising awareness of the complications of measles and enabling access to immunisations will be important parts of the solution.

Measles is highly infectious and can lead to serious complications, particularly in immunosuppressed individuals and young infants.
It is also more severe in pregnancy, and increases the risk of miscarriage, stillbirth, or preterm birth.

Individuals with suspected or known measles:

should be isolated immediately on arrival when attending health care settings to reduce the risk of other patients being exposed
all suspected measles cases should be promptly notified by phone to the local Health Protection Team (HPT) to facilitate timely public health action.

MMR vaccine:

all healthcare workers should have satisfactory evidence of protection against measles to protect both themselves and their patients. Satisfactory evidence of protection includes documentation of having received two or more doses of a measles containing vaccine and/or a positive measles IgG antibody test. Occupational Health service should have ready access to up-to-date records to support outbreak response.
children should receive their two doses of MMR vaccine on time at 12 months, and 3 years and 4 months.
the MMR vaccine can be given from six months of age before travel to a high-risk country.
patients over the age of three years and four months who do not have two recorded doses of MMR vaccine should be caught up opportunistically. There is no upper age limit to offering MMR vaccine.
new entrants from abroad and newly registered patients should have their immunisation history checked and missing doses caught up.
unvaccinated postnatal women should be offered any outstanding doses.

Under-vaccinated communities:

Health professionals who work with under-vaccinated communities should collaborate with local partners to raise awareness about measles with those most at risk and ensure unregistered populations can access immunisation services.
Resources including national guidelines for health professionals and free to order posters and leaflets for patients are listed in the appendix section in the full letter here.

Read Measles resurgence letter for professional organisations

Please also see:

Starting school: Is your child fully vaccinated?

As the new school year starts, with children about to start school for the first time, many parents will have a list of things needed for the big day: haircut, new shoes, school bag, etc. This is an exciting time for families. One important thing for the list is whether their child needs any vaccines. As children starting school will be mixing in larger numbers, the risk of catching infections increases.

Fortunately, although unpleasant, most of these such as cough and colds will be mild even if they are frequent! However, where numbers of unvaccinated children gather, there is also a risk of outbreaks of more serious infections.

Measles is top of the list of potentially serious infections where outbreaks are likely. This is because it is so highly infectious – considered the most infectious – and, to prevent outbreaks, very high uptake (95%) of two doses of measles, mumps, rubella (MMR) vaccine are needed. Unfortunately, this target vaccine uptake has never been met in the UK and current MMR vaccine uptake is the lowest for a decade: 2 in every 10 children in England have not had two doses of vaccine. In London, this figure is as high as ¼ of 5-year-olds entering school, while in some parts of the capital as many as a half of children are not fully vaccinated (NHS Digital 2023).

The situation is such in London that UKHSA has advised that, based on current vaccine uptake, there is the potential for an outbreak of between 40,000 and 160,000 cases (UKHSA 2023). These numbers make it inevitable that there would be many hospital admissions for measles, with complications such as pneumonia and encephalitis as well as deaths. Although large outbreaks are less likely in the country as a whole, there is this possibility where there are pockets of susceptible children, young people and adults.

So, what can be done? Fortunately, we have the means to prevent measles outbreaks through MMR vaccination. It is easy to check children’s vaccination status, by either looking at their red book or, if not available, checking with the GP surgery. Where vaccines are missing, they can be caught up at the GP surgery. Even though vaccines may have been missed at younger ages, for most there is no upper age limit, they can be caught up at any age. This does not require starting the course all over again – they just need the missing vaccines. Older children and young adults are also recommended to have had two doses of MMR vaccine, particularly those who are starting university in the next few months. This is particularly important as many young people missed out on their vaccines when they were young, and we have seen many cases of measles in recent outbreaks in this age group when disease is often more severe.

Don’t forget to also remind parents about the pre-school-booster vaccine. Usually offered at 3 years 4 months along with the second dose of MMR vaccine. This boosts immunity to diphtheria, tetanus, whooping cough and polio through the early school years and is an important part of the vaccine schedule.

Professor Helen Bedford – Professor of Children’s Health, Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health

References

Also see:

Parent Tips

PT – Childhood Immunisations Part 1: An introduction to childhood immunisations
This Parent Tip provides some useful information on the childhood vaccination programme, explaining how vaccines work, how they are regulated and why it is important to ensure that your baby receives all the recommended immunisations.
PT – Childhood Immunisations Part 2: Frequently asked questions
It is natural to have questions about your baby’s immunisations. This second part of our Parent Tip series on immunisations provides answers to “Frequently Asked Questions” and has been written by leading national experts. It covers FAQs on getting your baby immunised and what to expect, including information on things such as soothing your baby during and after vaccinations, and what to do if they are poorly on the day of their appointment.

Good Practice Points

GPP – Promoting the Uptake of Childhood Immunisations
The immunisation programme in the United Kingdom (UK) is a key component of the Healthy Child Programme. It is important for health visitors to be aware of current research and practice to promote immunisation uptake and know where to go for information.

New NICE quality standard – Flu vaccination: increasing uptake

The National Institute for Health and Care Excellence (NICE) has published a new quality standard on increasing the uptake of flu vaccinations among people who are eligible.

The quality standard discusses the following priority areas for improvement:

To use a range or combination of methods, such as phone, face-to-face, or social media communications, to invite people in eligible groups for flu vaccination. Commissioners are encouraged to review their services to make sure systems are in place to accommodate these different methods.
To include information within invitations to vaccination appointments about people’s individual situation or clinical risk. This will help eligible people understand the benefits of having a flu vaccine and why getting flu could be particularly risky for them.
To ensure health records are timely, accurate and consistent in order to improve the accuracy of uptake figures and reduce unnecessary invitations to those who have already had flu vaccinations.
To ensure employers enable health and social care staff who are in direct contact with vulnerable people to have flu vaccinations, including allowing flexibility during shifts.

Go to NICE Quality Standard - Flu vaccination: increasing uptake

PHE and NHS England urge eligible people to get free flu vaccine

Parents of 2 and 3-year olds are urged to protect their children against flu, which can be a serious and fatal illness.

Those aged 65 and over, children and adults with underlying medical conditions and pregnant women are also urged to get their free vaccine in the next few weeks, before flu begins to circulate widely.

The primary schools-based flu vaccination programme is once again underway. This follows a temporary pause in the ordering of the nasal vaccine, which was caused by delays from the manufacturer.

Primary school clinics will be rescheduled as soon as possible and children in high risk groups should visit their GP if their school session has been delayed, to ensure that they are protected early. GPs have now been advised to call in all eligible children for vaccination by early December.

Boys offered free HPV vaccine for the first time

From September 2019, boys in school year 8 will be offered the free Human Papilloma Virus (HPV) vaccine for the first time.

Worldwide, about 5% of all cancers are linked to the HPV virus. This includes cervical, penile, anal and genital cancers and some cancers of the head and neck – all of which the vaccine helps to protect against. Cervical cancer is currently the most common cancer in women under 35, killing around 850 women each year. HPV is thought to be responsible for over 99% of cervical cancers, as well as 90% of anal, about 70% of vaginal and vulvar cancers and more than 60% of penile cancers.

Modelling produced by the University of Warwick estimates that by 2058 in the UK the HPV vaccine currently being used may have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers. This would be 50 years after the introduction of the HPV vaccination programme, when people who were vaccinated as teenagers have reached the age groups that they would typically be affected by HPV-related cancers.

Girls have been offered the human papilloma virus (HPV) vaccine free from the NHS since 2008. So far, ten million doses of HPV vaccine have been given to young women in this country meaning over 80% of women aged 15-24 have received the vaccine. Since the introduction of HPV vaccination, infections of some types of HPV (HPV 16/18) in 16-21 year old women have reduced by 86% in England. A Scottish study also showed that the vaccine has reduced pre-cancerous cervical disease in women by up to 71%. Similarly, diagnoses of genital warts have declined by 90% in 15-17 year old girls and 70% in 15-17 year old boys due to the HPV vaccine.

Parents of girls and boys aged 12 and 13 should look out for information from their children’s school about the vaccine and timings for the jab. If they miss out on the vaccination for any reason they should talk to their school nurse/immunisation team about getting the vaccine at a later date.

More information about HPV vaccination for parents and their children is available here (see HPV).